A low-literacy asthma action plan to improve provider asthma counseling: A randomized study

H. Shonna Yin*, Ruchi S. Gupta, Suzy Tomopoulos, Alan L. Mendelsohn, Maureen Egan, Linda Van Schaick, Michael S. Wolf, Dayana C. Sanchez, Christopher Warren, Karen Encalada, Benard P. Dreyer

*Corresponding author for this work

Research output: Contribution to journalArticle

18 Scopus citations

Abstract

Background and Objectives: The use of written asthma action plans (WAAPs) has been associated with reduced asthma-related morbidity, but there are concerns about their complexity. We developed a health literacy-informed, pictogram-and photograph-based WAAP and examined whether providers who used it, with no training, would have better asthma counseling quality compared with those who used a standard plan. Methods: Physicians at 2 academic centers randomized to use a low-literacy or standard action plan (American Academy of Allergy, Asthma and Immunology) to counsel the hypothetical parent of child with moderate persistent asthma (regimen: Flovent 110 ìg 2 puffs twice daily, Singulair 5 mg daily, Albuterol 2 puffs every 4 hours as needed). Two blinded raters independently reviewed counseling transcriptions. Primary outcome measures: medication instructions presented with times of day (eg, morning and night vs number of times per day) and inhaler color; spacer use recommended; need for everyday medications, even when sick, addressed; and explicit symptoms used. Results: 119 providers were randomly assigned (61 low literacy, 58 standard). Providers who used the low-literacy plan were more likely to use times of day (eg, Flovent morning and night, 96.7% vs 51.7%, P <.001; odds ratio [OR] = 27.5; 95% confidence interval [CI], 6.1-123.4), recommend spacer use (eg, Albuterol, 83.6% vs 43.1%, P <.001; OR = 6.7; 95% CI, 2.9-15.8), address need for daily medications when sick (93.4% vs 34.5%, P <.001; OR = 27.1; 95% CI, 8.6-85.4), use explicit symptoms (eg, "ribs show when breathing," 54.1% vs 3.4%, P <.001; OR = 33.0; 95% CI, 7.4-147.5). Few mentioned inhaler color. Mean (SD) counseling time was similar (3.9 [2.5] vs 3.8 [2.6] minutes, P =.8). Conclusions: Use of a low-literacy WAAP improves the quality of asthma counseling by helping providers target key issues by using recommended clear communication principles.

Original languageEnglish (US)
Article numbere20150468
JournalPediatrics
Volume137
Issue number1
DOIs
StatePublished - Jan 2016

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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    Shonna Yin, H., Gupta, R. S., Tomopoulos, S., Mendelsohn, A. L., Egan, M., Van Schaick, L., Wolf, M. S., Sanchez, D. C., Warren, C., Encalada, K., & Dreyer, B. P. (2016). A low-literacy asthma action plan to improve provider asthma counseling: A randomized study. Pediatrics, 137(1), [e20150468]. https://doi.org/10.1542/peds.2015-0468